Best Life Alliance would love to share your story or photo to help support Home and Community Based Services. Submission may be used on the Best Life Alliance social media, on handouts, the webpage, or in email messages. Content may be edited by coalition team members for consistency, spelling, and grammar.

Simply complete this form and email a photo (if you have one) to bestlifealliance@gmail.com

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* 1. Your Name:

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* 2. How long have you worked as a DSP/Caregiver?

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* 3. What motivates you about your work? What do you love about your job?

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* 4. What are the challenges you face in this position? Have you or your family made any sacrifices because of your career as a DSP?

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* 5. What do you wish lawmakers knew about you and/or your work when they are making decisions at the Capitol?

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* 6. I give to the Best Life Alliance, its agents and assigns unlimited permission to use, publish and republish for purposes of advocacy and promotion of the cause, and for such use as it may determine, information and reproductions of my words and/or likeness (photographic, video, voice).
By initialing below and submitting this form, I am indicating my consent.

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* 7. Please indicate which you are agreeing to:

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* 8. Your Address (Street, City, State, Zip) OR Your Legislative Districts (Example: 66 /66A—find your districts at http://www.gis.leg.mn/iMaps/districts/. These numbers will be listed under the first two legislators that come up when you enter your address.)

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* 9. Phone (in case there are questions on your submission)

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* 10. Email (in case there are questions on your submission)

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* 11. I will email a photo and any corresponding consents to bestlifealliance@gmail.com

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